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The Real Cost of Volunteerism in EMS

The largest EMS subsidy in the U.S. is volunteer labor. With volunteers staffing more than 75 percent of the ambulance services in the nation, volunteerism amounts to a $3 billion-plus annual subsidy. For more than 40 years, this subsidy has allowed small towns with low call volumes to have local ambulance services, as volunteer labor kept costs low. But now, as the pool of willing and able volunteers dries up, we are beginning to understand just how costly this subsidy has been for EMS. 

This is not a critique of volunteer EMS workers. Some of the best examples of commitment, human compassion, sacrifice and professionalism are found in volunteer ambulance services. The dedication and service these Good Samaritans provide is nothing short of amazing. However, while volunteerism filled ambulance seats in small towns, it prohibited EMS from being seen as an essential public service that needs the same level of funding given to roads, sewers and law enforcement. Even the smallest and poorest of municipalities do not have volunteers fixing roads, teaching school, plowing snow, maintaining water supplies or staffing police departments; taxpayers know they have to pay for these services. But after 40 years of volunteer EMS, many taxpayers and communities still see EMS as more of a garden club than an essential community service, and this has fallout for EMS everywhere.   

Volunteerism has hidden and skewed the real cost of providing EMS in low-volume environments. Look at a volunteer ambulance service budget and you will see line items for vehicles, facilities, equipment, radios, fuel—but nothing reflecting the value of the volunteer labor subsidy. In 2009, the Bureau of Labor Statistics valued a volunteer hour at $21.36. Imagine if the volunteer ambulance service budgets and annual reports reflected this: Volunteers, taxpayers and governments would all have a much greater appreciation for the real costs of EMS.

Because these real costs are not recognized, volunteerism has propped up an inadequate fee-for-transport reimbursement system. A large portion of the cost of providing EMS is readiness, and nowhere is this seen more graphically than in the low-volume rural EMS system. If volunteerism did not subsidize EMS, the fee-for-transport funding system would quickly be seen as woefully inadequate because communities would have to start paying for the cost of readiness. In the big picture, a fee-for-transport funding system is neither practical nor ethical. It encourages use, discourages prevention and guarantees that the best and most advanced resources are located only in urban areas. 

Volunteerism has given the public the wrong impression about the skill and quality of the worker: It has told the public that almost anyone can do the job. This has led to a bipolar message. On one hand, the public is told that EMS is a profession requiring a unique set of medical skills and attitudes toward patient care and customer service with commensurate pay. On the other hand, volunteerism has told the public that anyone with a sturdy constitution and a little training can do the job. Which is it? Look at the results. Pay rates for unskilled and uncertified road construction laborers are often much higher than the pay rates for EMS workers. 

We could blame it on Jesus. He told the story about a traumatically injured man being aided and transported by a volunteer. However, the story recorded in the Gospel of Luke is not about the value of the Good Samaritan’s deed—it was offered as a response to the question, “Who is my neighbor?” Perhaps it is time to practice a new kind of neighborliness and start talking about the real value of the Good Samaritan’s deed.

For more information on the value of the volunteer’s time, visit